Managing Managed Care

Our inequitable, inefficient, oftentimes uncaring health care "system," revealed. -- Jeffrey G. Kaplan, M.D., M.S.

Med. Newsletter / eBook

Be informed on reform; Newsletter and, if requested, a relevant eBook: "Mgd Care 101 in 2016" (No obligation)

Subscribe to Managing Managed Care newsletter feed

SSL Certificate

All Contents

If/When Reform Fails to Reform

This article is posted in: 

The editorial, "If Reform Fails," says the status quo of health care reform is immoral, impractical and unsustainable. What did we expect when the House approved "Health Overhaul, Sending Landmark Bill to Obama"?  Nothing!

Battling Cancer Beyond Everything

This article is posted in: 

It is crazy to deny terminal patients access to possibly life-saving drugs for fear of offending the Statistics gods! Whether for-profit or not, insurance companies and the pharmaceutical industries are weighing in on experimental therapies; we have to be sure that reasonable  interventions are given a reasonable chance, and that reasonable costs can be factored in. Quoting my wife who is a two-time cancer survivor and advocate:

Getting More Value from Visits

This article is posted in: 

Be careful! 'What you sow, is what you reap.' A health plan's primary responsibility is ?? (should be the patients they insure).  But, they have policies that "restrain prescription medication spending by shifting costs toward patients. It is unknown how these policies have affected children with chronic illness."  Here's research that proves that cost control may not be about managing care--worse, it can adversely affect your health.

Yoga Therapy Prevents or Helps Treat Orthopedic Conditions

Bone fide alternative medicine approaches to common orthopedic problems. [Note: no controls] Regardless.... Loren Fishman, MD of Manhattan Physical Medicine and Rehabilitation is a personal friend and a Physiatrist, par excellence. Brody, Jane E. "Ancient Moves for Orthopedic Problems." Published, NY Times; August 1, 2011 Jane E. Brody, "12 Minutes of Yoga for Bone Health." NY Times, 12/21/15 [Dr. Lauren Fishman: in essence, yoga adherents seem to have less or no fractures.]

Access Problems

This article is posted in: 

When patients require specific therapies and an insurance company makes the frail or sickly patients jump thru hoops, denying or delaying care, it's time to move away from the insurance model.   How furious should we be when the insurer uses technicalities to refuse coverage, makes patients wait incessantly on the phone, transfers calls to G_d knows now many departments and then, after seemingly hours, the connection breaks, etc.?

Healthcare Reform/Economic Imperative

This article is posted in: 

Is health care reform merely cost-minimization, an opaque attempt to force economic responsibility? Simplifed, Here's the essence of health care reform and how to restore equity in access.... 1)    To reform care we must manage the care a)   The fact that delivery models vary or that they are evolving should not distract us from our goal to have effective care that is efficient and thereby cost-effective.  At the end of the day, however, it must be about the patient!